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Lets face it a lot of us snore. Various figures (ranging from 30 to 50%) on just how many adults snore are banded around but exact figures will always be difficult to collect because ‘snoring ‘is a bit of a taboo subject in many circles, it can break down marriages, friendships, affect sufferers physically and psychologically in many ways.
So no wonder most people deny being a snorer and even if they admit it, will usually play down its effects.
We do know problem snoring is more frequent in males, overweight persons and usually grows worse with age. We also know the other parties affected include partners and other members of the household and even neighbours with associated disturbed sleep patterns.
The main message to take home is snoring should not be ignored. Snoring means obstructed breathing and this obstruction can be serious.
However there are various self help measures and treatments available.
The noisy sounds of snoring are heard during sleep when there is an obstruction to free flow air through the air passages from your nose to back of your mouth and into your windpipe. This is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula (fleshy dangly thing at back of throat) and at night the muscles that keep your airways open relax and become more floppy. When these structures hit each other and vibrate during breathing as a result of the blockage causing irregular airflow, the noises of snoring occur. Usually the following are to blame;
Weakness or poor muscle tone in the tongue and throat. When they are too relaxed e.g from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway or the throat muscles can draw in from the sides restricting the size of the airway. This can also happen during deep sleep, particularly when sleeping on your back and unfortunately becomes more common as you get older.
Bulkiness of throat tissue. Overweight people have fat gathering in and around the throat, children with large adenoids or tonsils often snore and rarely cysts and tumours.
Problems with the shape of the mouth and soft tissues such as mispositioned jaw often caused by muscle tension, a long soft palate narrows the opening from the nose into the mouth causing a noisy flutter valve during relaxed breathing,a lond uvula makes matters worse.
Obstructed nasal passageways. A stuffy or ‘blocked’ nose requires extra effort ‘to pull’ the air through it creating an exaggerated vacuum in the throat pulling together the floppy tissues in the throat with the resultant snore. So viral (colds/flu) or bacterial infections, allergies ( including seasonal such as hay fever) and deformities of the nose structure (such as nasal septum blocking one channel) are common causes.
Smoking ca cause airways inflammation and blockage so smokers are much more likely to snore than non smokers.
Absolutely yes!
Medically it disturbs sleep patterns and deprives the snorer of appropriate rest, leading to increased irritability and moodiness, morning headaches, lack of concentration, issues with libido and a range of other mental performance tasks.
Longer term severe snoring can cause serious health problems such as Obstructive Sleep Apnea and raised risk of cardiovascular (such as heart attacks and irregular heart rhythms) and cerebrovascular disease (‘strokes’).
Socially, threat or divorce, physical injuries from partners, causing sleeplessness to the rest of the household, neighbours and being the centre of jokes and resentfulness are common problems.
If snoring is left unchecked, then it is believed by many healthcare professionals that in a large number of people this can subsequently lead to significant Obstructive Sleep Apnea Syndrome.
Depending upon the extent of upper airways obstruction, you would either have partial collapse of the soft tissues of the upper airway and produce a noise i.e. snoring, or with total obstruction of any portion of the collapsible airway, you can experience a condition called apnea which is a total stopping of breathing for 10 seconds or longer, or hypopnea which is a 50% or greater decrease in air exchange for 10 seconds or longer.
As a result of this obstruction C02 in your blood increases and the oxygen level in your blood decreases in proportion to the severity of your airway obstruction. This leads to a disruptive pattern of breathing which in turn disrupts sleep patterns, resulting in increased tiredness and ‘cant be botheredness’, morning headaches, irritability and a reduced concentration ability. All of this because you can’t get a ‘good nights sleep’.
These are the immediate and short term problems created by OSA, but the long term effects are not so easily recognised. These are the secondary effects on your heart and cardiovascular system that lead to an estimated 30,000 to 40,000 cardiovascular and or cerebrovascular (‘stroke’) deaths per year. Untreated OSA ultimately leads to an increase in the number of people developing pulmonary and systemic high blood pressure and ventricular hypertrophy (thickening of the heart muscle). In addition, significant decreases in the oxygen saturation of the blood during apneic episodes can lead to potentially lethal alteration in the rhythms of the heart (arrhythmia).
Treatment after diagnosis by a specialist involves wearing a dental splint and using a continuous positive airways pressure (CPAP) machine while you sleep keeping the nose, mouth or both properly ventilated.
Try and adopt a healthier diet and regular exercise to improve muscle tone and lose weight.
Avoid medication that can cause sleepiness
Avoid alcohol for atleast four hours and heavy meals or snacks for 3 hours before sleeping
Try and establish regular sleeping patterns
Sleep on your side rather than your back (use a pillow as a wedge)
Keep your nasal passageways clear particularly using a nasal device, or a humidifier steam or a few drops of eucalyptos or olabas oil (check with pharmacist re suitability).
It is important to stress snoring should not be ignored and medical advice sought if self help measures fail, particularly for heavy snorers.
Those who snore in any position or are disruptive to the family should seek medical advice to rule out obstructive sleep apnea. Initially through a GP but ultimately an Ear Nose and Throat specialist to provide a thorough examination and possibly sleep studies which can determine how serious the snoring is and effects on the snorer’s health.
The treatments depend upon the diagnosis and whether infection or physical obstructions or deformity are found.
Nasal devices and at severe end CPAP has already been mentioned. Surgical options other than removal of obstruction (e.g tonsils and adenoids) or correction of deformity (e.g nasal septoplasty or straightening nasal septum) are usually last resort and include;
Uvulopalatopharyngoplasty or UPPP for obstructive sleep apnea (OSA), tightening ‘flabby tissues in throat and palate’.
ThermalAblation Palatoplasty or TAP for snoring and OSA,utilises various laser techniques.
So in summary for the millions of ‘snorers’ out there or their ‘suffering partners’ take a positive step forward, there are things that can be done and help way before the talk of surgery begins or the ‘other half’ opens the door to the garage or suggests a trip to the solicitors!
Dr Mark Randle MBBS MRCGP
27th May 2008 |
